Health Care Utilization and Cost in Children and Adolescents With Chronic Pain

Abstract

The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.

Effect on Health Care Costs for Adolescents Receiving Adjunctive Internet-Delivered Cognitive-Behavioral Therapy: Results of a Randomized Controlled Trial

“…Contrary to our hypothesis, however, direct medical costs did not significantly change over time for youth in our sample. One prior uncontrolled cohort study of an inpatient pain rehabilitation program including psychological treatment also found no significant change in direct medical costs following treatment 32 . Although not previously studied, it is possible that treatment recommendations from pain clinic providers may lead to increases in some types of direct medical costs and decreases or no change in others.…”

“…Second, it is possible that more time may be needed to determine the impact of the adjunctive I-CBT program on health care costs. Among the handful of published studies that have evaluated change over time in health care costs among youth with chronic pain, all have been limited by the use of only two time points and none have examined trajectories beyond a 12-month follow-up period 10, 17, 18, 25, 32 . It is possible that realization of reductions in health care costs require a longer follow-up period (e.g., 3–5 years or more).…”

“…Indeed, high rates of health service use have been documented for youth with chronic pain around the world including in the United States 15, 29, 36, 40 , Europe 19, 30 , the United Kingdom 33, 41 , and Asia 26 . Recognizing this concern, economic impact was recommended as an important outcome domain to assess in clinical trials for pediatric chronic pain 32 .…”

Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review

“…Group and peer support, as well as family involvement, were additional behavioural components of many programs [ 21 , 22 , 28 – 30 , 33 – 35 , 37 , 38 , 40 , 42 , 44 – 48 , 50 – 53 , 56 – 61 , 65 – 70 , 73 – 75 , 79 – 81 , 83 , 85 , 87 , 89 , 90 , 92 – 94 , 96 , 103 , 104 , 106 , 108 – 112 ]. One program listed “agreement to family member or significant other involvement in treatment” as one of just five treatment inclusion criteria [ 61 ], another encouraged spouses to participate weekly in the inpatient program [ 22 ], and another included group psychotherapy for all patients [ 69 , 70 ].…”

“…Furthermore, health system or even national orientation towards opioids for the management of chronic pain is a prevalent contextual factor. In included studies from countries such as Denmark [ 32 , 63 , 71 ], Germany [ 21 , 78 , 94 ] or the UK [ 19 , 22 , 31 , 42 , 50 ] where there were no prevailing concerns about opioid use, MDC programs did not employ, let alone require, opioid tapering. In such situations, there were no consistent reductions in opioid use, even when pain and behaviours improved.…”